Surgical resection for duodenal neuroendocrine neoplasia: Outcome, prognostic factors and risk of metastases

Nießen, Anna; Bergmann, Frank; Hinz, Ulf; Schimmack, Simon; Hackert, Thilo; Büchler, Markus W.; Strobel, Oliver

doi:10.1016/j.ejso.2020.01.030

Cited by 10 publications

(11 citation statements)

References 41 publications

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“…This latter assertion was seen in the IS‐NET group as there was no difference in RFS or OS for patients that had lymph node involvement. Interestingly, one study showed that angioinvasion was the strongest predictor of OS in patients with duodenal NETs, 31 a finding not confirmed here. The extent and modality of surgical resection has been of particular interest given the high morbidity associated with radical resection in this area, and currently the European Neuroendocrine Tumor Society guidelines recommend endoscopic resection for non‐ampullary tumors less than 1 cm 36 .…”

Section: Discussioncontrasting

confidence: 88%

“…The predictors, and outcomes resulting from, nodal metastases in periampullary NETs has been the focus of several prior studies. The rate of lymph node involvement in the literature ranges from 46% to 88% 1,7,25‐28 for ampullary and 26%–82% for duodenal NETs 1,2,17,28‐32 . Ampullary histology, 16,33 grade, 25 increasing tumor size (>1.5–2 cm), 2,19,34 and depth of invasion 32 have all been demonstrated to be positive predictors of lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Previous small series have demonstrated similar disease free survival rates for ampullary NETs of 56% at 3 years 33 and 66% and 5 years, 8 with population level data demonstrating 5 and 10 year OS of 82% and 71% 25 . Reported 5‐year RFS and OS rates for duodenal NETs are 81% 18 and 66%–94%, 1,8,19,31,35 respectively. In addition, median OS of 187 months 29 and disease free survival of 156 months has been reported for duodenal NETs 17 .…”

Section: Discussionmentioning

confidence: 99%

“…When examining our patients with duodenal NETs less than 1 cm, who had lymph node sampling, 50% had lymph node metastases. To this end, there have been several studies examining the impact of a local or endoscopic approach without traditional lymphadenectomy with survival data remaining somewhat inconsistent to this point 1,18,31 . This is a topic that clearly requires additional study.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of lymph node involvement in the literature ranges from 46% to 88% 1,7,[25][26][27][28] for ampullary and 26%-82% for duodenal NETs. 1,2,17,[28][29][30][31][32] Ampullary histology, 16,33 grade, 25 increasing tumor size (>1.5-2 cm), 2,19,34 33 and 66% and 5 years, 8 with population level data demonstrating 5 and 10 year OS of 82% and 71%. 25 Reported 5-year RFS and OS rates for duodenal NETs are 81% 18 and 66%-94%, 1,8,19,31,35 respectively.…”

Section: Stage and Survival Analysismentioning

confidence: 99%

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Duodenal, ampullary, and pancreatic neuroendocrine tumors: Oncologic outcomes are driven by tumor biology and tissue of origin

Schmocker

Wright

Ding

et al. 2020

Journal of Surgical Oncology

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BackgroundPeriampullary neuroendocrine tumors (NETs) arise from the duodenum, ampulla, and periampullary pancreas. Duodenal and ampullary NETs are rare and may have distinct biologic behavior from pancreatic NETs (P‐NETs). We examined the outcomes of these entities.MethodsAn institutional database was queried for patients undergoing resection for pancreatic head, duodenal, or ampullary NETs from 2000 to 2018. Patients with MEN1 syndrome or follow up less than 12 months were excluded.ResultsThree hundred and ten patients were identified. Tumor locations were ampulla (n = 15), duodenum (n = 35) and pancreas (n = 260). Median follow‐up and recurrence‐free survival (RFS) were 60.9 (interquartile range [IQR]: 34.8–99.3) and 171.7 (IQR: 84.0–NR) months. Clinicopathologic data and survival outcomes were similar for duodenal and ampullary NETs (RFS: p = .347 and overall survival [OS]: p = .246) and were combined into an intestinal subtype (IS) group. There were no differences in OS or RFS when comparing IS‐NET and P‐NET. On multivariate analysis, tissue of origin was not associated with risk of recurrence. The current American Joint Committee on Cancer staging guidelines, which account for origin tissue, were predictive of outcomes for all subtypes.ConclusionTissue of origin does not appear to impact long‐term outcomes when comparing IS‐NETs and P‐NETs. The AJCC staging system offers good discriminatory capacity in the context of the tissue type.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Stage and Survival Analysismentioning

confidence: 99%

See 3 more Smart Citations

Duodenal, ampullary, and pancreatic neuroendocrine tumors: Oncologic outcomes are driven by tumor biology and tissue of origin

Schmocker

Wright

Ding

et al. 2020

Journal of Surgical Oncology

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Duodenal neuroendocrine neoplasms on enhanced CT: establishing a diagnostic model with duodenal gastrointestinal stromal tumors in the non-ampullary area and analyzing the value of predicting prognosis

Feng,

Chen,

et al. 2023

J Cancer Res Clin Oncol

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Objective To identify CT features and establish a diagnostic model for distinguishing non-ampullary duodenal neuroendocrine neoplasms (dNENs) from non-ampullary duodenal gastrointestinal stromal tumors (dGISTs) and to analyze overall survival outcomes of all dNENs patients. Materials and methods This retrospective study included 98 patients with pathologically confirmed dNENs (n = 44) and dGISTs (n = 54). Clinical data and CT characteristics were collected. Univariate analyses and binary logistic regression analyses were performed to identify independent factors and establish a diagnostic model between non-ampullary dNENs (n = 22) and dGISTs (n = 54). The ROC curve was created to determine diagnostic ability. Cox proportional hazards models were created and Kaplan–Meier survival analyses were performed for survival analysis of dNENs (n = 44). Results Three CT features were identified as independent predictors of non-ampullary dNENs, including intraluminal growth pattern (OR 0.450; 95% CI 0.206–0.983), absence of intratumoral vessels (OR 0.207; 95% CI 0.053–0.807) and unenhanced lesion > 40.76 HU (OR 5.720; 95% CI 1.575–20.774). The AUC was 0.866 (95% CI 0.765–0.968), with a sensitivity of 90.91% (95% CI 70.8–98.9%), specificity of 77.78% (95% CI 64.4–88.0%), and total accuracy rate of 81.58%. Lymph node metastases (HR: 21.60), obstructive biliary and/or pancreatic duct dilation (HR: 5.82) and portal lesion enhancement ≤ 99.79 HU (HR: 3.02) were independent prognostic factors related to poor outcomes. Conclusion We established a diagnostic model to differentiate non-ampullary dNENs from dGISTs. Besides, we found that imaging features on enhanced CT can predict OS of patients with dNENs.

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Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases

et al. 2022

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Neuroendocrine neoplasms (NENs) of the major and minor ampulla are rare diseases with clinico-pathologic features distinct from non-ampullary-duodenal NENs. However, they have been often combined and the knowledge on prognostic factors specific to ampullary NENs (Amp-NENs) is limited. The aim of this study was to identify factors associated with metastatic potential and patient prognosis in Amp-NENs. We clinically and histologically investigated an international series of 119 Amp-NENs, comprising 93 ampullary neuroendocrine tumors (Amp-NETs) and 26 neuroendocrine carcinomas (Amp-NECs). Somatostatin-producing tubulo-acinar NET represented the predominant Amp-NET histologic subtype (58 cases, 62%, 12 associated with type 1 neurofibromatosis). Compared to Amp-NETs, Amp-NECs arose in significantly older patients and showed a larger tumor size, a more frequent small vessel invasion, a deeper level of invasion and a higher rate of distant metastasis, and, importantly, a tremendously worse disease-specific patient survival. In Amp-NETs, the WHO grade proved to be a strong predictor of disease-specific survival (hazard ratio: 12.61, p < 0.001 for G2 vs G1), as well as patient age at diagnosis > 60 years, small vessel invasion, pancreatic invasion, and distant metastasis at diagnosis. Although nodal metastatic disease was not associated with survival by itself, patients with > 3 metastatic lymph nodes showed a worse outcome in comparison with the remaining Amp-NET cases with lymphadenectomy. Tumor epicenter in the major ampulla, small vessel invasion, and tumor size > 16 mm were independent predictors of nodal metastases in Amp-NETs. In conclusion, we identified prognostic factors, which may eventually help guide treatment decisions in Amp-NENs.

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Surgical resection for duodenal neuroendocrine neoplasia: Outcome, prognostic factors and risk of metastases

Cited by 10 publications

References 41 publications

Duodenal, ampullary, and pancreatic neuroendocrine tumors: Oncologic outcomes are driven by tumor biology and tissue of origin

Duodenal, ampullary, and pancreatic neuroendocrine tumors: Oncologic outcomes are driven by tumor biology and tissue of origin

Duodenal neuroendocrine neoplasms on enhanced CT: establishing a diagnostic model with duodenal gastrointestinal stromal tumors in the non-ampullary area and analyzing the value of predicting prognosis

Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases

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